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Nonparametric Methods
Published in Marcello Pagano, Kimberlee Gauvreau, Heather Mattie, Principles of Biostatistics, 2022
Marcello Pagano, Kimberlee Gauvreau, Heather Mattie
Suppose we would like to investigate the use of the drug amiloride as a therapy for patients with cystic fibrosis. It is believed that this drug may help to improve air flow in the lungs, and thereby delay the loss of pulmonary function often associated with the disease. Forced vital capacity (FVC) is the volume of air that a person can expel from the lungs in 6 seconds; we would like to compare the reduction in FVC that occurs over a 25-week period of treatment with the drug to the reduction that occurs in the same patients over a similar period of time during treatment with a placebo. However, we are not willing to assume that differences in reduction in FVC are normally distributed.
Diaphragmatic Ultrasound after Thoracic and Abdominal Surgery
Published in Massimo Zambon, Ultrasound of the Diaphragm and the Respiratory Muscles, 2022
Luigi Vetrugno, Daniele Orso, Elena Bignami, Gianmaria Cammarota
Depending on the intervention type, thoracotomy surgery is associated with postoperative pulmonary complications in 25–35% of patients, the occurrence of which may increase the probability of ICU admission, hospital length of stay, and mortality [18]. Direct injury to the diaphragm fibres or phrenic nerve and diaphragmatic weakness due to decreased postoperative mechanics play a significant role in the pathogenesis of pulmonary complications. However, their incidence seems to be lower after video-assisted thoracoscopic surgery (VATS) [19]. Recently, in an elegant work by Spadaro et al., which assessed postoperative patients in spontaneous breathing by means of the Boussuges technique, diaphragmatic dysfunction of less than 10 mm was found to positively correlate with the onset of post-surgical pulmonary complications [19]. Once again, their incidence was lower following VATS. Diaphragm dysfunction was diagnosed in 55% of patients undergoing video-assisted thoracoscopic surgery and in 83% in the thoracotomy group. A higher impairment in forced vital capacity was found in the latter. In this study, patients exhibiting diaphragmatic dysfunction within 24 hours after surgery also experienced more postoperative pulmonary complications. In the majority of cases, the ipsilateral diaphragm was involved.
Respiratory Diseases
Published in Amy J. Litterini, Christopher M. Wilson, Physical Activity and Rehabilitation in Life-threatening Illness, 2021
Amy J. Litterini, Christopher M. Wilson
COPD, previously known as emphysema, is a life-threatening respiratory diagnosis characterized by chronic inflammation and obstruction of the alveoli, or air sacs, of the lungs. COPD is considered a combination of those diagnosed with emphysema, an abnormal accumulation of air secondary to damaged and scarred alveoli, and chronic bronchitis, or inflammation of the mucous membranes of the bronchial tubes. For individuals presenting with symptoms such as cough, sputum production, dyspnea, and/or exposure to known risk factors, a formal diagnosis of COPD is made via spirometry. Confirmatory results of spirometry include measurements of forced vital capacity (FVC), the total volume during exhalation, as well as the volume of air exhaled in the first second, known as the forced expiratory volume in one second (FEV1). COPD is then staged from 1 (mild) to 4 (severe), where results of spirometry are compared to normative values to distinguish staging and monitor the status of disease.
The effects of spinal stabilization exercises in patients with myasthenia gravis: a randomized crossover study
Published in Disability and Rehabilitation, 2022
Ali Naim Ceren, Yeliz Salcı, Ayla Fil Balkan, Ebru Çalık Kütükçü, Kadriye Armutlu, Sevim Erdem Özdamar
Respiratory functions were assessed with a portable spirometer (Fitmate MED spirometer, Cosmed, Rome, Italy) in line with the guidelines of the American Thoracic Society and the European Respiratory Society. The patients were placed in an upright sitting position and their noses were covered with a plug. An air-tight mouthpiece was placed in the patients' mouths. Patients were asked to breathe normally several times and immediately afterwards, patients were asked to breathe as much as they could. They were then asked to exhale with force and evacuate their lungs as much as they could. During both inspiration and expiration maneuvers, the physiotherapist guided the patient with his instructions (verbally motivating expressions in breathing) to reach the patient's maximum level. This test was repeated three times for each patient, and the best predicted value was recorded. A 1-min rest period was given between each test. In this measurement, the forced vital capacity (FVC) and the forced expiratory volume in the first second (FEV1) values were obtained. In order to obtain the slow vital capacity (SVC) value, the physiotherapist asked the patients to breathe and exhale more slowly while the patients were in the same position. The physiotherapist motivated the patients to reach their maximum levels. Maneuvers were continued until a plateau was formed in the device in both inspiration and expiration. This test was repeated three times for each patient and the best predicted value was recorded. A 1-min rest period is given between each test [25].
Tocilizumab and rituximab for anti-MDA-5 positive amyopathic dermatomyositis complicated with macrophage activation syndrome and progressive fibrosing interstitial lung disease
Published in Scandinavian Journal of Rheumatology, 2022
A 50-year-old man presented to our rheumatology clinic with a 1 month history of dyspnoea on exertion and skin eruptions in June 2017. Physical examination disclosed inverse Gottron’s sign with painful purpuric flat skin lesions on the palmar aspect of the proximal and distal interphalangeal joints, scaling and ulcerations at the digital pulp (Figure 1A), and periungual erythema (Figure 1B). Serial evaluation disclosed high-titre MDA-5 antibody, elevated lactate dehydrogenase and alanine aminotransferase, and mild lymphocytic infiltration in muscle biopsy, but normal serum concentration of creatine phosphokinase. Pulmonary function tests revealed reduced forced vital capacity (FVC, 69% predicted value). Computed tomography (CT) of the chest found subpleural interlobular septal thickening (Figure 1E). A diagnosis of anti-MDA-5 antibody-positive amyopathic dermatomyositis with ILD was made. He received monthly steroid pulse therapy (methylprednisolone 1000 mg/day for 3 days) three times and one course of intravenous immunoglobulin (IVIG, 0.4 g/kg/day for 3 days), followed by maintenance prednisolone combined with one disease-modifying anti-rheumatic drug at a time, namely, hydroxychloroquine (400 mg/day), azathioprine (100 mg/day), or mycophenolic acid (360 mg/day). The skin lesions persisted, while lung function deteriorated gradually, warranting home oxygen therapy.
A multimodal approach to detect and monitor early lung disease in cystic fibrosis
Published in Expert Review of Respiratory Medicine, 2021
Pedro Mondéjar-López, Alexander Horsley, Felix Ratjen, Silvia Bertolo, Helene de Vicente, Òscar Asensio de la Cruz
Spirometry is the most common lung function test used for the diagnosis and monitoring of CF. Spirometry measures the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled, and is usually expressed as forced expiratory volume in 1 second (FEV1), the volume of air that can be forcibly exhaled in 1 second after full inspiration, and forced vital capacity (FVC), the volume of air that can be forcibly exhaled after full inspiration. The FEV1/FVC ratio is used to diagnose airflow obstruction while percent predicted FEV1 is used to classify disease severity and monitor disease progression [24]. The flow–volume loop also provides useful information, with a concave expiratory loop shape and a low maximal mid-expiratory flow index indicating that small airway dysfunction is present, even when FEV1 or FEV1/FVC levels are within the normal range [25].